Treatment Of Hodgkin's Disease Research Articles

Langerhans Cell Histiocytosis Following Hodgkin Lymphoma in Adult: A Case Report

Introduction: Langerhans cell histiocytosis (LCH) is a very rare disorder, and usually considered a disease of childhood. It is rarely observed in adults. Its etiopathogenesis remains to be elucidated. One possible etiological cause is a reactive proliferation of Langerhans cells following chemotherapy or radiotherapy for Hodgkin's disease (HD). Eosinophilic granuloma is the benign accumulation of histiocytes located primarily in the bones, but which also affects other organs, including the skin, lungs and lymph nodes. The time interval between LCH occurrence and previous lymphoma is variable. The occurrence of eosinophilic granuloma in a patient with Hodgkin disease has rarely been reported. Objective: This case report aimed to describe the clinic-pathological, histopathological, immunohistochemical and other features of LCH and to analyze LCH clinical features for improving diagnosis and decreasing misdiagnosis rate. Case report: In this report, a 38-year-old female presented with LCH twenty-two months after diagnosis and treatment of nodular sclerosing HD. The patient presented with generalized lymphadenopathy and general weakness. The Langerhans cells diffusely infiltrated in the inguinal lymph node and the tumor cells were positive for CD1a and S-100 expression. The patient received chemotherapy and show complete remission. Conclusion: LCH has a very rare occurrence following HD in adult. The definitive diagnosis depends on pathological biopsy and immunohistochemistry. Although specific therapeutic approach hasn't been well established, combined chemotherapy for multisystem lesions and surgical operation or radiotherapy for unifocal lesions may improve the therapy.

Sperm DNA methylome abnormalities occur both pre- and post-treatment in men with Hodgkin disease and testicular cancer

BackgroundCombination chemotherapy has contributed to increased survival from Hodgkin disease (HD) and testicular cancer (TC). However, questions concerning the quality of spermatozoa after treatment have arisen. While studies have shown evidence of DNA damage and aneuploidy in spermatozoa years following anticancer treatment, the sperm epigenome has received little attention. Our objectives here were to determine the impact of HD and TC, as well as their treatments, on sperm DNA methylation. Semen samples were collected from community controls (CC) and from men undergoing treatment for HD or TC, both before initiation of chemotherapy and at multiple times post-treatment. Sperm DNA methylation was assessed using genome-wide and locus-specific approaches.ResultsImprinted gene methylation was not affected in the sperm of HD or TC men, before or after treatment. Prior to treatment, using Illumina HumanMethylation450 BeadChip (450 K) arrays, a subset of 500 probes was able to distinguish sperm samples from TC, HD and CC subjects; differences between groups persisted post-treatment. Comparing altered sperm methylation between HD or TC patients versus CC men, twice as many sites were affected in TC versus HD men; for both groups, the most affected CpGs were hypomethylated. For TC patients, the promoter region of GDF2 contained the largest region of differential methylation. To assess alterations in DNA methylation over time/post-chemotherapy, serial samples from individual patients were compared. With restriction landmark genome scanning and 450 K array analyses, some patients who underwent chemotherapy showed increased alterations in DNA methylation, up to 2 to 3 years post-treatment, when compared to the CC cohort. Similarly, a higher-resolution human sperm-specific assay that includes assessment of environmentally sensitive regions, or “dynamic sites,” also demonstrated persistently altered sperm DNA methylation in cancer patients post-treatment and suggested preferential susceptibility of “dynamic” CpG sites.ConclusionsDistinct sperm DNA methylation signatures were present pre-treatment in men with HD and TC and may help explain increases in birth defects reported in recent clinical studies. Epigenetic defects in spermatozoa of some cancer survivors were evident even up to 2 years post-treatment. Abnormalities in the sperm epigenome both pre- and post-chemotherapy may contribute to detrimental effects on future reproductive health.

A CASE OF HODGKIN LYMPHOMA PRESENTING AS NEPHROTIC SYNDROME

Paraneoplastic glomerulopathy has been reported in patients with malignancy.In particular, the association of Nephrotic Syndrome (NS) with Hodgkins Lymphoma (HL) is rare and there are few reports in the literature. Minimal change nephropathy is the most frequently observed renal lesion whereas this association appears, either simultaneously or within several months of each other. Nephrotic changes as part of the paraneoplastic syndrome are rare in lymphoid malignancies. 1% of cases of Hodgkins Lymphoma cases may present with nephrotic syndrome. We are reporting a case which initially presented as nephrotic syndrome and later was diagnosed to have of Hodgkins Lymphoma and managed accordingly. This report presents the case of a 13-year-old male in whom the diagnosis of NS was established six months before the diagnosis of Hodgkin lymphoma. Once chemotherapy was initiated, proteinuria and the clinical manifestations of NS, mainly oedema, disappeared. Considering that the NS can be a paraneoplastic manifestation of Hodgkin lymphoma, the careful clinical evaluation becomes mandatory in any child with NS and persistent proteinuria despite appropriate treatment protocol. The prognosis of these patients is good, the treatment of Hodgkin disease causing the disappearance of proteinuria.

Anaplastic Large Cell Lymphoma Hodgkin's-Like: A Randomized Trial of ABVD Versus MACOP-B With and Without Radiation Therapy

AbstractDuring the last few years, morphological, immunohistochemical, and genetic findings have placed anaplastic large cell lymphoma (ALCL) as a distinct clinicopathologic entity, and several reports have focused on the existence of different subtypes of the tumor. Particular attention has been paid to the ALCL–Hodgkin's-like (HL) subtype, which seems to be on the border between Hodgkin's disease (HD) and high-grade non-Hodgkin's lymphoma (HG-NHL). From September 1994 to July 1997, during the course of an Italian multicentric trial, 40 ALCL-HLs were randomized to receive as front-line chemotherapy MACOP-B (methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin—a third-generation HG-NHL regimen) or ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine—a scheme specific for HD). All patients with bulky disease in the mediastinum at diagnosis underwent local radiotherapy after the chemotherapeutic program. Complete response (CR) was achieved in 17 of the 19 (90%) patients who were treated with MACOP-B, and in 19 of the 21 (91%) patients who were administered ABVD. The probability of relapse-free survival, projected at 32 months, was 94% for the MACOP-B subset and 91% for the ABVD subset. The majority of patients with mediastinal bulky disease obtained CR (evaluated with 67Ga single photon emission computed tomography [SPECT]) after their radiotherapy. The present study suggests that ALCL-HL, in line with its borderline status, responds in an equivalent way to third-generation chemotherapy for HG-NHL and to conventional HD treatment in terms of both CR and relapse-free survival rates. However, as to the latter, a longer follow-up period may be needed before stating the absolute equivalence of the two regimens used.© 1998 by The American Society of Hematology.

Многоцентровая кооперативная проспективно-ретроспективная наблюдательная программа по оценке методов диагностики и лечения лимфомы Ходжкина в Северо-Западном Федеральном округе РФ

Многоцентровая кооперативная проспективно-ретроспективная наблюдательная программа по оценке методов диагностики и лечения лимфомы Ходжкина в Северо-Западном Федеральном округе РФ

Feasibility and Acceptability of a Web Site to Promote Survivorship Care in Survivors of Hodgkin Disease.

Evaluate rates of enrollment, completion, and patient-reported acceptability of an educational survivorship-care Web site for survivors of Hodgkin disease (HD). The study was a mixed-method evaluation design. Eligible participants were adults who had completed treatment of a primary diagnosis of HD ≥ 2 years before enrollment. Patients were recruited through postal mail and telephone and were asked to review a Web site, complete an adapted version of the Acceptability E-scale (total score of 24 or greater indicates acceptability), and respond to a structured telephone or e-mail interview to discuss experiences with the Web site. Of 259 potentially eligible participants identified by medical record review, 124 survivors had confirmed contact with study staff and were invited to participate; 63 people (50.8%; 90% CI, 43% to 59%) enrolled; 37 participants (58.7%) were men. The median age at time of enrollment was 51.0 years (range, 29.3 to 80.0 years), and the median time since completion of treatment of HD was 14.9 years (range, 3 to 38.75 years). Overall, 82.5% of those enrolled viewed all Web site content. Forty-eight participants completed the acceptability survey, which resulted in a mean acceptability score of 26.5 (standard deviation, 3.5). The majority of enrollees (67%) completed a follow-up interview. Overall, HD survivor participants viewed the content and reviewed it favorably. A Web-based intervention is a promising way to provide survivors of HD with information about how to manage the long-term and late effects from cancer and treatment, and provide trusted survivorship resources.

Radiation Induced Squamous Cell Carcinoma of the Tongue after Hodgkin Disease treatment: Case Report and Literature Revue

Radiation Induced Squamous Cell Carcinoma of the Tongue after Hodgkin Disease treatment: Case Report and Literature Revue

Radiation-induced coronary artery disease: a second survivorship challenge?

10.2217/FON.15.121 © 2015 Future Medicine Ltd The role of adjuvant mediastinal radiation (RT) in improving disease-free survival in Hodgkin’s disease and breast cancer (BC) is well known. However, this survival advantage is accompanied by the late cardiac sequelae of radiation. Radiationinduced coronary artery disease (RICAD) is a challenging clinical entity and a major contributor to cardiovascular (CV) mortality in cancer survivors. In this review, we discuss the pathophysiology, surveillance and management challenges of RICAD.

The Paris Conference “La Radiothérapie de la Maladie de Hodgkin”: A First Step in the Cure of Hodgkin Disease

The year 2015 marks the 50th anniversary of the Paris Conference, “La Radiothérapie de la Maladie de Hodgkin.” This meeting, devoted to Hodgkin disease, was held at the Hôpital Saint Louis on February 15, 1965. It was organized by Maurice Tubiana and George Mathé and hosted by Jean Bernard. It marked a turning point in the management of Hodgkin disease, beginning its transformation from a highly fatal disease into one that is now almost 90% curable. At this meeting there were important contributions to our basic understanding of the pathology, staging, and treatment of Hodgkin disease.

Radiation-induced breast cancer in women with Hodgkin's disease

Aim and backgroundThe aim of this study is to analyze the main clinical and pathologic characteristics of radiation-induced breast carcinomas (BC) following treatment for Hodgkin's disease (HD) and to identify the risk factors for their induction. To create a mathematical model for the prediction of expected age at which a BC might develop based on the age at treatment for HD. Materials and methodsThirty-nine cases of women with BC that developed after treatment for HD in puberty or adolescence were analyzed retrospectively. The median age at initiation of treatment for HD was 12.9 years (9–21). The median age at diagnosis of the second malignancy – breast carcinoma was 32.4 years (22.9–39). ResultsThe distribution of patients according to the clinical T stage of breast cancer was as follows: 11 patients with T1 stage BC (28%), 22 with T2 stage (56%) and 6 with stage T3 (16%). Prevalent were tumors localized in the lateral breast quadrants. The observed 5 year survival was 95%. ConclusionThe risk of solid tumors, especially breast cancer, is high among women with HD disease who were treated with radiotherapy in their childhood. In this article, we propose a specific mathematical age formula which could be used as predictive equation when the age of the treatment for HD is in the range between 9 and 21 years. Systematic screening for breast cancer in these patients would be significantly important for their health and could improve their survival.

Bone marrow necrosis in a girl with Hodgkin’s disease

Bone marrow necrosis (BMN) is a rare finding in children with malignancy occurring most commonly in children with acute lymphoblastic leukemia. This article describes the first case of a girl who developed BMN during treatment for Hodgkin's disease. During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia and leukoerythroblastosis. MRI studies showed multiple confluent areas with low signal intensity and rim contrast enhancement in all vertebral bodies. Bone marrow biopsy revealed focal necrosis within hypocellular bone marrow. The patient responded quickly to symptomatic treatment with analgetics and heparin; however, elevations of LDH and D-Dimer persisted for 1.5 and 8 months, respectively. Clinicians should be aware of this rare condition to establish the diagnosis and to continue oncologic treatment as early as possible.

Cancer du sein après maladie de Hodgkin

Secondary breast cancer represents 6 to 9% of secondary neoplasia after treatments for Hodgkin Disease (HD). Mostly, they appear 10 years after the end of treatments for HD. The most important risk factors are mantle field irradiation and the young age. The means of screening and treatments are still in discussion. We report a case of bilateral intraductal and invasive carcinoma that occurred 16 years after treatments for HD, developing its particularities in diagnosis and treatment, particularly place of conservative treatments and sentinel lymph node biopsy.

Parathyroid Adenoma and Chondrosarcoma After Treatment of Pediatric Hodgkin Disease

Treatment of Hodgkin disease (HD) with chemoradiotherapy in children is associated with increased risk for developing secondary neoplasms. Parathyroid adenoma (PTA) and chondrosarcoma (CS) are quite rare types of secondary neoplasms after HD. We describe a 5-year-old boy with stage IV HD, successfully treated with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone)/ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy followed by 35 Gy mantle radiotherapy who developed primary hyperparathyroidism because of benign PTA at the age of 20 years, and died of CS in thoracic vertebrae at the age of 22 years. Consecutive occurrence of PTA and CS after treatment of pediatric HD, to the best of our knowledge, has not been reported earlier.

EARLY [18F]FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY–BASED RESPONSE EVALUATION AFTER TREATMENT WITH GEMCITABINE AND VINORELBINE FOR REFRACTORY HODGKIN DISEASE: A CHILDREN’S ONCOLOGY GROUP REPORT

The International Harmonization Project defined complete response (CR) after treatment for Hodgkin disease (HD) by absence of fluorodeoxyglucose avidity, regardless of the size of residual masses. Residual avidity after initial treatment is known to predict inferior survival. In the setting of retrieval therapy, early positron emission tomography (PET) scans may improve assessment of treatment efficacy. Retrospective analysis after 2 cycles of gemcitabine and vinorelbine for refractory HD revealed 6 CR among 13 patients by PET and 1 CR in 13 by computed tomography (CT). No relationship between PET response and event-free or overall survival could be discerned, presumably because of the heterogeneity of subsequent therapies.

Breast Cancer Following Hodgkin’s Disease: The Experience of the University of Florence

The advent of effective chemo-radiotherapy has made Hodgkin Disease (HD) a highly curable malignancy, but the great improvement in survival rates allowed the observation in long-term survivors of several treatment complications. Secondary malignancies are the most serious complications and breast cancer (BC) represents the most common solid tumor among female survivors. The aim of our analysis is to describe the clinico-pathological characteristics and management of BC occurred after HD treatment. Between 1960 and 2003, 2,039 patients were treated for HD at the Department of Radiotherapy-Oncology of the Florence University. In this study we considered 1,538 patients on whom a minimum follow up of 6 months had been obtained. Of these, 725 were women. The most represented histological subtype was nodular sclerosis (50.6%). Supradiaphragmatic alone or with subdiaphragmatic complementary extended field radiotherapy was delivered to 83.1% of patients while supradiaphragmatic involved field radiotherapy was delivered to 10.7% of patients. Concerning the characteristics and incidence of BC, we focused our analysis exclusively on the female group. We found that BC occurred in 39, with an overall incidence of 5.4%. The mean interval after Hodgkin treatment was 19.5 years (SD +/- 9.0). The median age of BC diagnosis was 50.8 years (SD +/- 13.3) while the median age of Hodgkin diagnosis was 31.2 years (SD +/- 14.5). Thirty-seven women received mediastinal irradiation. We observed a decreasing trend of the secondary BC incidence with increasing age of Hodgkin treatment with the maximum incidence registered in women treated at age 20 or younger. In Our Institute we perform a whole life follow up and recommend that annual mammography begins 10 years after HD treatment or, in any case, not later than age 40.

Osteonecrosis in Children Treated for Lymphoma or Solid Tumors

The purpose of this study was to find out the incidence of and clinical risk factors for magnetic resonance imaging (MRI)-detected osteonecrosis (ON) in children treated for lymphoma or solid tumors. The development of ON was studied in 32 childhood cancer patients who underwent MRI scanning of the lower extremities at the end of their treatment. The underlying malignancy was Wilms tumor in 8 patients, non-Hodgkin lymphoma (NHL) in 8, Hodgkin disease (HD) in 7, rhabdomyosarcoma in 6, and other occasional solid tumors in 3 patients. Six of the 32 patients (19%) had ON. The mean age of the patients with ON at diagnosis was 12.7 years compared with 5.8 years for the patients without ON (P<0.001). All the patients with ON had either HD (4 patients) or NHL (2 patients). Two (33%) of the patients with ON were symptomatic. ON in MRI was found to be a common complication in children after treatment for HD or NHL. The risk for ON seems to be very low in patients with other solid tumors even when they receive high cumulative doses of dexamethasone.

Secondary malignant neoplasms among children and adolescents following treatment for Hodgkin disease

10055 Background: While 90% of patients diagnosed with Hodgkin disease (HD) during childhood are successfully treated, these patients remain at risk for late effects from these therapies. The objective of the current study was to evaluate the frequency of and risk factors for secondary malignant neoplasms (SMNs) among a cohort of HD patients who were treated at Roswell Park Cancer Institute (RPCI) between 1960 and 1989. Methods: This was a retrospective cohort study of 182 previously untreated patients with HD who were younger than 20 years of age at the time of diagnosis and were referred to RPCI between 1/1/1960 and 12/31/1989; follow-up extended through 12/31/2007. Sex- and age-specific person-years at risk were accumulated and applied to gender, age-, and time period-specific cancer incidence rates for New York State, excluding New York City. Standardized incidence ratios (SIRs), and 95% confidence intervals, were calculated for overall cancer incidence and by type of therapy. Results: Of 182 individu...

Lungenfunktion nach Bestrahlung bei pädiatrisch-onkologischen Patienten

Lung function tests were performed in 22 children and juveniles who had received radiotherapy to the lungs, an average of 9.5 years previously, for tumour (14 with Hodgkin's disease [aged 7-22 years], 4 with malignant non-Hodgkin lymphoma [aged 6-14 years], 3 with Wilms tumour [4-6 years], and one with Ewing's sarcoma [aged 16 years]). All three patients who, as young children, had had radiotherapy to both lungs because of a Wilms tumour with multiple lung metastases had restrictive disorders of lung function. Four of 12 after treatment of Hodgkin's disease and one of two after malignant non-Hodgkin lymphoma and extensive thoracic irradiation developed a restrictive disorder of pulmonary function. But all four patients who had irradiation restricted to the mediastinum had normal lung functions.

Mammographic Screening in Women at Increased Risk of Breast Cancer after Treatment of Hodgkin’s Disease

Treatment regimens for Hodgkin's disease (HD) that have included radiation to lymph node regions in the thorax have contributed to high rates of long-term disease-free survival. However, incidental radiation exposure of breast tissue in young women has significantly increased the risk of breast cancer compared to expected rates in the general population. After informing patients about risks associated with previous treatment of HD, we studied screening mammograms and call-back rates in women at increased risk for developing breast cancer at a younger age. We contacted by mail a cohort of 291 women between 25 and 55 years of age who had received thoracic irradiation before 35 years of age for HD with or without chemotherapy. Subjects were offered information about risks identified after HD therapy with questionnaires to assess response to this information. Ten patients refused participation, 93 did not respond, and 21 were excluded after they reported a prior diagnosis of invasive (1) or in situ (2) breast cancer. One hundred and sixty seven women received information about secondary breast cancer risk and were advised to initiate or maintain mammographic screening. Available mammograms were reviewed by two radiologists and classified according to the ACR BI-RADS Mammography Lexicon. Abnormal findings were correlated to pathology results from biopsies. One hundred and fifteen subjects reported that they obtained new mammograms during the period of the study. Ninety-nine were available for secondary review. Patients were studied an average of 16.9 years after HD treatment (Range: 4.5-32.5 years) at an average of 41 years of age (range 25-55 years). High density breast tissue was identified in 60% (60/99). Seventeen of the women (17.2%) were recalled for further imaging. This was more common in women with heterogeneously dense breast tissue. Seven of those recalled (41%) were advised to undergo biopsies that identified ductal carcinoma in situ (DCIS) in one and benign findings in the others. Among 16 women whose mammograms were unavailable for review, three were diagnosed with DCIS; two of these had microscopic evidence of invasive breast cancer. The four in situ or microinvasive cancers were diagnosed in the study participants at 25-40 years of age and from 5 to 23 years after HD therapy. Biopsies were performed because mammograms detected microcalcifications without palpable abnormality in three of these cases. Women who have had thoracic nodal irradiation for Hodgkin's disease have an increased risk of developing secondary breast cancer at an unusually young age. As expected in younger women, high density breast tissue was common on mammography, and the recall and biopsy rates were unusually high. However, early mammographic screening facilitated diagnosis of in situ and early invasive cancer in 3.5% of our subjects.

Sperm Cryopreservation: Recent and Marked Increase in Use for Testicular Cancer Compared With Hodgkin Disease

In a public network of sperm banks, time trends in use of sperm cryopreservation by men with testicular cancer (TC) and Hodgkin disease (HD) were assessed from 1990 to 2004. During this period, overall incidence of sperm cryopreservation rose from 1.08 to 3.06 per 100 000 person-years for TC and from 0.79 to 1.20 for HD. Modeling suggests that in 2010 the expected rate will reach 5.90 per 100 000 for TC, compared with 1.39 for HD. This increase in sperm cryopreservation for TC and HD is similar to increases observed in incidence of these 2 diseases in France and other European countries. Although TC and HD are rare malignancies, they are the most common cancers in adolescents and young men (Bray et al, 2002). Recent advances in chemotherapy and/or radiotherapy treatments have improved the longterm survival of patients with these diseases (5-year survival rate is approximately 90%). Nevertheless, the side effects of treatment, especially infertility (decrease of 30%), are still a major preoccupation for these young patients who often have not yet fathered children (Huyghe et al, 2004). Accordingly, sperm cryopreservation and sperm banking are now offered to these men before treatment to preserve their capacity to conceive naturally or through assisted reproduction techniques (Hallak et al, 1999; Magelssen et al, 2005). With this aim in mind, a unique public network of sperm banks (Centre d’Etude et de Conservation des Oeufs et du Sperme [CECOS]) was created in France in 1984, and 22 centers now cover the whole country. Sperm banks appear to be increasingly used for sperm donation and to offer the possibility of preserving sperm in the event of disease or surgical treatment, especially for men with HD and TC (Agarwal, 2000). The recent and marked increase of these diseases in most industrialized countries is a major concern (Parkin et al, 1997), drawing the attention of oncologists to the need for sperm cryopreservation. Although this option is still underutilized, it is now becoming a good and safe practice to safeguard future fertility (Chung et al, 2004). The aim of this study was to assess time trends in the use of sperm banking over the period of 1990 to 2004 by men with TC or HD.